Clinical Outcomes of Splenic Injury

PURPOSE: The management of splenic injuries has shifted from a splenectomy to splenic preservation owing to immunity. The purpose of this study was to assess the kinds of management and outcomes through a review of our experience with splenic injuries. METHODS: We retrospectively reviewed 47 patients with traumatic splenic injuries using by electronic medical records from Jan. 2007 and Dec. 2011. Splenic injuries were classified according to the American Association for the Surgery of Trauma (AAST) grading system. RESULTS: There were 11 falls, 11 traffic accidents, 10 motorcylcle accidents, 10 pedestrian accidents and 5 abdominal blunt traumas. Low-grade injured patients ( or =Grade IV) were 18 of 43(38.3%). In 34 patients, non-surgical treatment was performed, and 14 patients underwent a splenectomy. There were relatively more high-grade in older patients, and the highgrade-injury group showed need for a transfusion (p=0.002), more need for a splenectomy (p<0.001), a longer mean hospital stay (p=0.036), a longer ICU stay (p=0.045) and more combined organ injury (p=0.036). CONCLUSION: Conservative treatment should be considered in low-grade-injury patients (< or =Grade III). A Splenectomy was performed on 56% of the patients with Grade IV injuries, so a splenectomy should be considered carefully in such patients. In patients with a grade V injury, we think surgical treatment may be needed.

Intraluminal Duodenal Diverticulum Causing Chronic Gastrointestinal Bleeding in Adults

Intraluminal duodenal diverticulum (IDD), 'windsock web', is known to be a rare congenital condition observed in the adult, sometimes causing an obstruction, pancreatitis, and acute/chronic bleeding. We experienced a case of intraluminal duodenal diverticulum associated with a chronic gastrointestinal bleeding in a young adult man. This condition was identified during the examination for an intermittent melena through a gastroduodenoscopy and an upper gastrointestinal series, revealing a lesion between the second and third portion of the duodenum. Laparotomy was planned for its management. A duodenotomy and excision of the diverticulum was performed and showed good results.

Clinical Analysis of 501 Cases of Mid-trimester Genetic Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: To analyze the change of indications and chromosomal abnormalities according to pateint's age and indications in midtrimester genetic amniocentesis. METHODS: This study reviewed 501 prenatal genetic amniocentesis cases from June 1995 to April 2004 which were done at Presbyterian Medical Center. We analized the changes of the indication, age distribution and chromosomal results according to maternal age and indications of amniocentesis. RESULTS: In 501 cases, the most common maternal and gestational age distributions were 30-34 years old and 17 weeks (32.54% and 25.98%, respectively). Abnormal maternal serum markers were the most common indications for amniocentesis (46.9%), and followed by old age (24.96%), combined old age and abnormal maternal serum screening (14.38%), ultrasonographic abnormality (4.60%). The overall incidence of chromosomal abnormalities were 3.79% (19 cases), of which numerical abnormalities and structural abnormalities were 1.79% (9 cases) and 2.0% (10 cases), respectively. In autosomal disorders, Down syndrome 4 cases, translocation 3 cases, mosaicism 2 cases, deletion 1case were diagnosed. In sex chromosomal disorders, Turner syndrome 1 case and mosaicism 2 cases (Turner syndrome 1 case, Triple X chromosome 1 case) were diagnosed. No statistic significance was found among different age groups. Those who had ultrasonographic abnormalities were found to have correlation with chromosomal abnormalities than other indications. CONCLUSION: Among the several indications for prenatal cytogenetic diagnosis, ultrasonographic abnormalities and abnormal maternal serum markers might be important indications. Especially, ultrasonographic abnormalities could be the most predictive markers for abnormal fetal karyotypes.

Congenital left ventricular septal aneurysm associated with coronary fistula / 대한내과학회지

Congenital left ventricular aneurysm is rare, poorly understood, and potentially lethal. Also, congenital coronary artery fistula is rare but hemodynamically, it induces myocardial ischemia due to coronary steal syndrome and diastolic volume overload from a left to left shunt. A 64-year-old women with abnormal ECG and mild exertional dyspnea was admitted to our hospital for further evaluation. Electrocardiography demonstrated Q waves, inverted T waves in the inferior leads and right bundle brach block. Transthoracic electrocardiography showed left ventricular septal aneurysm. Cardiac catheterization, a selective left coronary arteriogram revealed a fistula. The fistula originated from the proximal portion of the left anterior descending coronary artery and drained into the left ventricle. Magnetic resonance imaging demonstrated congenital defect muscular portion of interventricular septum. Thallium 201 heart spect showed regional perfusion defect along the inferior-lateral segment of the left ventricle. Then we report an congenital left ventricular septal aneurysm associated with coronary fistula.

Congenital left ventricular septal aneurysm associated with coronary fistula / 대한내과학회지

Congenital left ventricular aneurysm is rare, poorly understood, and potentially lethal. Also, congenital coronary artery fistula is rare but hemodynamically, it induces myocardial ischemia due to coronary steal syndrome and diastolic volume overload from a left to left shunt. A 64-year-old women with abnormal ECG and mild exertional dyspnea was admitted to our hospital for further evaluation. Electrocardiography demonstrated Q waves, inverted T waves in the inferior leads and right bundle brach block. Transthoracic electrocardiography showed left ventricular septal aneurysm. Cardiac catheterization, a selective left coronary arteriogram revealed a fistula. The fistula originated from the proximal portion of the left anterior descending coronary artery and drained into the left ventricle. Magnetic resonance imaging demonstrated congenital defect muscular portion of interventricular septum. Thallium 201 heart spect showed regional perfusion defect along the inferior-lateral segment of the left ventricle. Then we report an congenital left ventricular septal aneurysm associated with coronary fistula.

The Effect of Hydrogen Peroxide on the Migration and FAK Activation in Lens Epithelial Cells

PURPOSE: Hydrogen peroxide has been implicated as a causative factor of various cellular dysfunction, cell death, transformation. In addition, oxidative stress has been suggested as a crucial inducer of cataract formation not only the nuclear-type cataract but also anterior polar type cataract. Transformation of lens epithelial cells accompanying accumulation of extracellular matrix molecules, and cell migration is observed in the cataract forming area of lens. In the present study, we investigated in the migration of lens epithelial cells and the activation of focal adhesion kinase(FAK), because there have been many reports showing that activation of FAK increased cell migration. METHOD: After treatment hygrogen peroxide in a dose-dependent on HLE B-3 cell line, we have performed immuno fluorenscence staing of actin stress fiber and migration assay, and then isolated total RNA to identify expression of MMP-2 from the cell line. To examine FAK activity, we are performed Phosphotyrosine Immunoblot analysis. RESULT: We observed the increased cell migration in response to hydrogen peroxide in a dose dependent manner. In addition, we observed that the phosphorylation of focal adhesion kinase was increased with the treatment of hydrogen peroxide. Also, we examined the expression of the matrix metalloproteinases-2(MMP-2) which disintegrates extracellular matrix and participates in cell migration. The result showed that the mRNA level of MMP-2 did not increase by hydrogen peroxide. CONCLUSIONS: The results suggest that hydrogen peroxide enhanced migration of lens epithelial cell, and that FAK may play a role in the process of cell migration. In conclusion, migration of lens epithelial cell and phosphorylation of focal adhesion kinase was increased by treatment of hydrogen peroxide. Thus oxidative stress plays a crucial role in the transformation of lens epithelial cells and anterior polar type cataract formation.

Role of the Vt i reous in Branch Retinal Vein Occlusion in Association with Macular Edema and Neovascularization

The main cause of decreased visual acuity in branch retinal vein occlusion (BRVO) are macular edema and vitreous hemorrhage due to retinal neovascularization.We retrospec- tively studied the association of macular edema, neovas- cularization and vitreous hemorrhage according to the vitreoretinal relationship in 51 eyes of 51 BRVO patients. The eyes were classified as having vitreomacular attachment (VMA) or vitromacular separation (VMS) and posterior vitreous detachment (PVD) state and studied macular edema and retinal neovascularization development according to the vitreoretinal realtionship. The prevalence of VMA was 37 (72.5%) of the eyes and VMS was 14 (27.5%) eyes. VMA group had macular edema in 75.7% (28 of 37 eyes)and no macular edema was present in VMS group.Those 42 eyes who had partial or no PVD, 35.7% (15 of 42 eyes)developed retinal neovascularization and 9 eyes of complete PVD did not occur neovascularization. Although no significant relationship was found, vitreous hemorrhage developed in 21.4% (9 of 42 eyes) of only partial or no PVD group. VMA and PVD state may influence the presence of macular edema and retinal neovascularization in association with BRVO.